The tear ferning test: a simple clinical technique to evaluate the ocular tear film

This is the peer reviewed version of the following article: Masmali, A. M., Purslow, C., & Murphy, P. J. (2014). The tear ferning test: a simple clinical technique to evaluate the ocular tear film: The tear ferning test. Clinical and Experimental Optometry, 97(5), 399–406., which has been published in final form at https://doi.org/10.1111/cxo.12160. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.A healthy tear film is very important for many major functions of the ocular surface. Dry eye disease is a significant clinical problem that needs to be solved but the poor correlation between clinical signs and reported symptoms makes it difficult for the clinician to apply a scientific basis to his clinical management. The problem is compounded by the difficulties of evaluating the tear film due to its transparency, small volume and complex composition. Practical insight into tear film composition would be very useful to the clinician for patient diagnosis and treatment but detailed analysis is restricted to expensive, laboratory-based systems. There is a pressing need for a simple test. The tear ferning test is a laboratory test but it has the potential to be applied in the clinic setting to investigate the tear film in a simple way. Drying a small sample of tear fluid onto a clean, glass microscope slide produces a characteristic crystallisation pattern, described as a ‘tear fern’. This test is currently not widely used because of some limitations that need to be overcome but several studies have demonstrated its potential. Such limitations need to be resolved so that tear ferning could be used in the clinic setting to assess the tear film

Development of a new grading scale for tear ferning

The final publication is available at Elsevier via https://dx.doi.org/10.1016/j.clae.2013.09.011" © 2014. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Purpose: This paper reports on the development of a new tear ferning (TF) subjective grading scale, and compares it with the Rolando scale. Method: TF patterns obtained from tear film samples collected from normal and dry eye subjects in previous studies were collated into a large image library. From this library, 60 images were selected to represent the full range of possible TF patterns, and a further sub-set of 15 images was chosen for analysis. Twenty-five optometrists were asked to rank the images in increasing order between extreme anchors on a scale of TF patterns. Interim statistical analysis of this ranking found 7 homogeneous sub-sets, where the image rankings overlapped for a group of images. A representative image (typically the mean) from each group was then adopted as the grade standard. Using this new 7-point grading scale, 25 optometrists were asked to grade the entire 60 image library at two sessions: once using the 4-point Rolando scale and once using the new 7-point scale, applying 0.25 grade unit interpolation. Results: Statistical analysis found that for the larger image set, the Rolando scale produced 3 homogeneous sub-sets, and the 7-point scale produced 5 homogeneous sub-sets. With this refinement, a new 5-point TF scale (Grades 0–4) was obtained. Conclusions: The Rolando grading scale lacks discrimination between its Type I and II grades, reducing its reliability. The new 5-point grading scale is able to differentiate between TF patterns, and may provide additional support for the use of TF for both researcher and clinician

Application of a new grading scale for tear ferning in non-dry eye and dry eye subjects

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.clae.2014.09.007 © 2014. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Purpose: To apply the Masmali tear ferning (TF) grading scale on non-dry eye (NDE) and dry eye (DE) subjects to test the validity of the grading scale in practice, and to describe the grading scale range for NDE and DE. Method: Forty NDE subjects (20 males, 20 females) and 40 DE subjects (23 males, 17 females) ranging in age from 19 to 53 years (mean ± SD: 25.3 ± 5.5) with no other ocular disease, no contact lens wear, and not pregnant or breastfeeding were recruited. McMonnies scores were used for subject grouping. Phenol red thread (PRT) and slit-lamp test were used. A tear sample was collected from right eye, which was then dried to produce a ferning pattern, that was observed using a digital microscope, and graded. Results: Mean McMonnies, PRT and TF grade in NDE subjects were 7.1 ± 3.8, 27.4 ± 4.3 mm and 0.78 ± 0.40, respectively. Median McMonnies, PRT and TF grade in DE subjects were 16.5 ± 3.0, 9.0 ± 2.0 mm and 2.3 ± 1.48, respectively. In NDE subjects, grades 0.0–1.8 were observed (82.5% Grade 0.0–1.00). Grades 2.0–4.0 were observed in DE subjects (72.5% Grades 2.0–3.0). For all subjects, there were large correlations between TF grade and PRT (r = −0.79), PRT and McMonnies (r = −0.60), and TF and McMonnies (r = 0.73). Conclusions: The Masmali TF grading scale showed good validity in describing the TF patterns. Grades ≥2 can be classified as abnormal patterns. The TF test has the potential to be used in the clinic

Resilient Operator-Robot Collaboration in Smart Flexible Manufacturing Systems

Manufacturing key metrics are a useful approach for evaluating shop floor operations. The collaboration between operators and robots is essential in maintaining a resilient performance within smart and flexible manufacturing systems. For effective collaboration, both operators and robots must possess varying degrees of resilience, including full resilience, partial resilience and the ability to handle total disruptions. In this paper, lead time is considered a significant key metric. When the system is fully resilient and dependable, it achieves the optimal lead time. Consequently, lead time serves as a benchmark for evaluating the system's performance. However, if the robot experiences significant performance issues, it can negatively impact the cycle time, resulting in longer lead times. The discrepancy between the optimal lead time and the lead time obtained during partial or complete disruption is subtracted from the optimal lead time. To ensure the validity of the findings, mathematical equations are utilized in combination with other relevant data. This approach contributes to the knowledge base in the field. Finally, the paper will provide suggestions for future research endeavors.

A mixed-methods study of examining the concerns of Saudi Arabian middle and secondary school teachers in adopting the Future Gate Learning Management System: a transformation to digital learning

Doctor of PhilosophyCurriculum and Instruction ProgramsKay Ann TaylorThe purpose of this mixed-method study was to examine the concerns of teachers in middle and secondary schools as they began to implement the Future Gate LMS in Saudi Arabia. A sample of 1045 teachers participated in this study, who represent teachers from schools selected by the Ministry of Education to implement the transformation to digital learning through the Future Gate LMS project. The study examined teachers’ concerns through the lens of the Concern Based Adoption Model (CBAM) framework. The data in this sequential mixed-method study were obtained through two phases. The first phase was quantitative data through the Stage of Concern Questionnaire (SoCQ) and the second phase was qualitative data through an open-ended question on the SoCQ as well as semi-structured interviews. The results from the SoCQ indicated that teachers in the middle and secondary schools who were selected to implement the Future Gate LMS were in the early concern stages. The highest percentile score was Stage 0 Unconcern 87% followed by Stage 1 Personal 84%, Stage 2 Informational 83%, and Stage 3 Management 73%. The lowest percentile score was in Stage 4 Consequences 54% followed by Stage 5 Collaboration 59% and Stage 6 Refocusing 69%. A one-way MANOVA test revealed a statistically significant difference between teachers’ stages of concerns and their gender and type of degree. It also revealed statistically significant differences between teachers’ stages of concerns and their technographic characteristics (prior experience in educational technology use, type of professional development in educational technology, duration of professional development in educational technology, type of professional development in Future Gate LMS, and duration of professional development in Future Gate LMS). One-way MANOVA also revealed statistically significant differences between teachers’ stages of concerns and technology availability in the classroom (technology in the classroom and Internet access in the classroom). The qualitative data analysis indicated that the top three concerns of teachers were centered around technology and Internet in the school, Future Gate LMS activation, and how students deal with Future Gate LMS. This study contributes to the literature to understand teachers’ needs for successfully implementing innovations. Results obtained from this study are important for all stakeholders so that they can understand teachers’ concerns regarding adopting the transformation to digital learning in Saudi Arabia as it is an important project for the Saudi Arabia 2030 vision

Repeatability and Diurnal Variation of Tear Ferning Test

This is a non-final version of an article published in final form in: Masmali, A. M., Al-Bahlal, J. M., El-Hiti, G. A., Akhtar, S., Purslow, C., Murphy, P. J., & Almubrad, T. (2015). Repeatability and Diurnal Variation of Tear Ferning Test: Eye & Contact Lens: Science & Clinical Practice, 41(5), 262–267. https://doi.org/10.1097/ICL.0000000000000116Objectives: To investigate tear ferning (TF) test repeatability between sessions by observing changes in the tear fern pattern during the day. Methods: Twenty-three healthy young adults (15 men and 8 women), ranging in age from 20 to 32 years (mean±SD: 22.9±3.3 years) without signs or symptoms of dry eye disease, ocular disease, or contact lens wear were enrolled in the study. Schirmer I, tear break-up time (TBUT) test, and McMonnies questionnaire were used to screen volunteers. Schirmer I and TBUT tests were applied to both eyes in each subject. Four samples of tear fluid were collected from the right eye of each subject using glass capillaries at set intervals during a single day (9 AM, 11 AM, 2 PM, and 4 PM). The TF patterns obtained from samples were classified according to the Masmali TF grading scale to increments of 0.1. Results: The median values obtained from the McMonnies, Schirmer, and TBUT tests were 4.0±2.0, 30.0±7.0 mm (OD), and 16.0±10.0 sec (OD), respectively. There were no statistically significant differences between the TF grades for tear samples collected at different times of the day (Wilks' Lambda, P=0.351). The majority (84.8%) of TF grades was between 0.0 and 1.5; the remaining 15.2% of subjects had TF between grades 1.6 and 1.9. The overall mean grade for the TF was 1.1±0.3. There were small insignificant correlations between TF grades and the McMonnies questionnaire (r=0.1.30) and TBUT (r=0.248) and a negligible correlation with Schirmer test (r=−0.046). Conclusions: The results found no significant differences within the TF for tear samples collected at different times of the day, suggesting that there is little diurnal variation evident.The authors extend their appreciation to the College of Applied Medical Sciences Research Center and the Deanship of Scientific Research at King Saud University for its funding of this research

Internet of Things Adoption for Saudi Healthcare Services

Background: Recent studies in information systems have predicted that applications of the Internet of Things (IoT) innovations will revolutionise various sectors including healthcare. Besides the issues and opportunities of IoT based innovations, existing studies have shown limitations to advance the adoption of IoT-understanding and relevant interventions to benefit researchers and healthcare practitioners. Method: In this context, a systematic literature review study was conducted to re-position a qualitative, phenomenological investigation that could offer useful insights into the factors affecting IoT-adoption in a developing country’s healthcare service. In addition to it, five participants who worked in hospitals and clinics in Jazan, Saudi Arabia, took part in the semi-structured interviews developed based on the diffusion of innovation theory. Results: The study explored the relevant literature and evaluated how the outcome is used to identify the key delivers of IoT in healthcare. Conclusions: According to the findings, the capacity of the Saudi healthcare sector to accept and implement a new IT with IoT technologies is increasing and its integrations remains a debated issue

Hopf algebra and noncommutative differential structures.

In this thesis I will study noncommutative differential geometry, after the style of Connes and Woronowicz. In particular two examples of differential calculi on Hopf algebras are considered, and their associated covariant derivatives and Riemannian geometry. These are on the Heisenberg group, and on the finite group A4. I consider bimodule connections after the work of Madore. In the last chapter noncommutative fibrations are considerd, with an application to the Leray spectral sequence. NOTATION. In this thesis equations are numbered as round brackets (), where (a.b) denotes equation b in chapter a, and references are indicated by square brackets []. This thesis has been typeset using Latex, and some figures using the Visio program